Treatment of Angina Pectoris with Propranolol: the Harmful Effects of Cigarette Smoking

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Abstract
The effects of smoking on the treatment of angina were studied in 10 patients. Each patient underwent 4 randomized 1-wk treatments consisting of on-and-off smoking and on-and-off propranolol (360 mg/day). At the end of each treatment a maximal exercise test was performed using 16 precordial leads. Smoking was associated with a significantly higher heart rate, blood pressure, area and severity of ST-segment depression. This was not abolished by propranolol. Smoking aggravates the simple hemodynamic variables used to assess myocardial O2 requirements and the ECG signs of ischemia; this is true even after treatment with propranolol.

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